Definition & Overview
Debridement is a common medical procedure used to clean any kind of wound. In cases of an open fracture or dislocation due to trauma wherein foreign objects or fragments are lodged in the wound, treatment requires the removal of the said objects to facilitate proper healing and prevent infection.
Who Should Undergo and Expected Results
A procedure that combines debridement and the removal of foreign material is commonly performed in patients suffering from:
Open fracture – This refers to a broken bone that becomes exposed to the environment due to a break in the skin. The amount of exposure can vary from a small puncture to a large open wound. Most open fractures are caused by high-impact trauma, such as a direct blow to the affected body part or a collision with a motor vehicle. It can also occur due to a twisting injury.
Open dislocation - Also known as a compound dislocation, this refers to a bone that becomes dislocated and causes an opening, or wound, through the skin.
Since an open fracture or dislocation is exposed to the environment, it is possible for some contaminants to enter the body. These may include:
- Broken glass
The debridement and the removal of foreign materials are parts of the initial treatment, which is often followed by bleeding control, antibiotic therapy, a detailed assessment of the injury, and stabilisation and protection of the injured site. Without proper debridement and removal of foreign materials, the wound will not heal properly and patients will be at risk of infection. Also, if a foreign object is not detected and removed, its continued presence in the body may cause:
- Cosmetic deformity
- Chronic pain
- Functional impairment
How is the Procedure Performed?
For the procedure, the patient is placed under anaesthesia and the injured site is examined. In most cases, local anaesthesia is sufficient for this purpose.
The procedure begins with proper irrigation of the wound to reduce the risk of an infection. When large volumes of irrigating agents are used at adequate pressures, they can effectively eliminate most foreign bodies in a wound. In most cases, the pressure is set at around 5 to 8 PSI, which is delivered through a 16 to 19-gauge catheter and a 35-65 mL syringe. Most doctors use a sterile isotonic saline solution as the main irrigating agent.
However, since cases vary in complexity, doctors use a variety of techniques for this procedure. To be certain that all foreign materials are removed, patients usually undergo imaging scans as well. All damaged tissues are then removed through a normal debridement procedure. The wound is then closed and dressed properly before the patient is discharged.
Possible Risks and Complications
Although a wound debridement is a routine procedure, it becomes more complicated when it involves the removal of foreign material at the site of an open fracture or dislocation. In such cases, there are some potential complications that may arise during the procedure, which may include:
- Missed foreign materials, or those that are not detected and therefore not removed, resulting in the retention of the said foreign object
- Misdiagnosis or incorrect assessment of the damage to the injured site
- Unsuccessful removal
- Removal that caused additional (unnecessary) tissue damage
These complications place the patient at a greater risk of wound infection.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun. 58(4):453-8.
Hao J, Cuellar DO, Herbert B, Kim JW, Chadayammuri V, Casemyr N, et al. Does the OTA Open Fracture Classification predict the need for limb amputation?A retrospective observational cohort study on 512 patients.J Orthop Trauma.